Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail:, Web:
(New Admission Diploma in Nautical Science )


  Dossier ID:
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: khatib shaiban shakil
Mother's Name: fatima
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 02 Sep 2000 Nationality: Indian
Place of Birth: Mumbai Personal Identification Mark: NA
Blood Group: O + Address for Communication: sai kutir, plot no.A36,37, 1st floor, 101. Sector 23, Nerul east.
State: Maharashtra Country: India
Pin: 400706 City/District: Nerul
Mobile no: 9833638583 Telephone No. with STD code:
Aadhar Card No:757936244677 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: fatima s khatib Relationship with candidate: mother
Parents Date of Birth: 10 Feb 1968 Parent's/Guardian's Occupation/Designation: housewife
Office Address:
Address: sai kutir, plot no.A36,37, 1st floor, 101. Sector 23, Nerul east.
Country: India State: Maharashtra
City/District: Nerul Pin: 400706
Tel: Mobile no.: 9820673474
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2015 Year of Passing: 2017
Board: Maharashtra Board: Maharashtra
School: st.augustine School: ss school and college
City: Nerul City: Nerul
English %: 81 Board Roll No./Seat No.: M012543
Aggregate Percentage: 71 School/College Code: 1615039
  Centre code: 1143
  Address of School/College: seawoods sector 44.
  Pin: 400706
  Contact Nos:
  Aggregate Percentage: 59
Details of Marks Secured in (10+2) Examination -

Physics 100 38 38
Chemistry 100 77 77
Mathematics 100 41 41
Physics, Chemistry & Mathematics combined Percentage: 52
English 100 62 62
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?:
Why do you wish to join TMI?:
What are your hobbies?:
What are your strengths?:
What are your weaknesses?:
How do you intend to meet the expenses of this program?: 
Review you documents:
Birth certificate not uploaded DGS Approved Medical Fitness Certificate not uploaded Class X marksheet not uploaded School leaving certificate not uploaded Class XII admit card not uploaded Class XII marksheet not uploaded

I hereby declare that all the statements made above are true and correct.

Signature of Candidate



Date ________________

Print Summary and Application Form